Basic Information
| Provider Information | |||||||||
| NPI: | 1124474226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FEDERMAN | ||||||||
| FirstName: | SHAINA | ||||||||
| MiddleName: | FRAIDA MUSHKA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CNM | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TORON-FEDERMAN | ||||||||
| OtherFirstName: | SHAINA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8110 ROYAL PALM BLVD STE 108 | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330655742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543418288 | ||||||||
| FaxNumber: | 9543415165 | ||||||||
| Practice Location | |||||||||
| Address1: | 8110 ROYAL PALM BLVD STE 108 | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330655742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543418288 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2016 | ||||||||
| LastUpdateDate: | 03/14/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | ARNP9327852 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 363L00000X | ARNP9327852 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.